Dehydroepiandrosterone (DHEA)

[Guest guest]

Good Morning!

 

A special thanks to Dr. Arron Bowen of Columbia University and

Hospital for this comprehensive research on DHEA.

 

Dehydroepiandrosterone (DHEA)

 

DHEA is the most prevalent of the hormones produced by the adrenal

glands. After being secreted by the adrenal glands, it circulates in

the bloodstream as DHEA-sulfate (DHEAS) and is converted as needed

into other hormones. Supplementation with DHEAS has resulted in

increased levels of testosterone and androstenedione, two steroid

hormones.3

 

The conversion of DHEA into testosterone4 may account for the fact

that low blood levels of DHEA have been reported in some men with

erectile dysfunction. The findings of a double-blind trial using 50

mg supplements of DHEA taken daily for six months suggests that DHEA

may improve erectile function in some men.5

 

 

Little is known about how dehydroepiandrosterone (DHEA) works in the

body.1 Confusing the picture is the fact that DHEA often has

different effects in men, premenopausal women, and postmenopausal

women.2

 

 

Some,6 7 but not all,8 9 clinical trials have found that DHEA

supplementation lowers fat mass without reducing total body weight.10

In one trial, the reduction in fat mass occurred in men but not in

women.11

 

DHEA is believed to indirectly affect blood sugar levels, but

information remains incomplete and contradictory. Attempts to affect

blood sugar levels in humans have led to improvements,12 no effect,13

and, at very high amounts (1,600 mg DHEA per day), a worsening of

tolerance to sugar.14

 

DHEA modulates immunity. A group of elderly men with low DHEA levels

who were given 50 mg of DHEA per day for 20 weeks, experienced a

significant activation of immune function.15 Postmenopausal women

have also shown increased immune functioning in just three weeks when

given DHEA in double-blind research.16

 

Some reports have suggested that DHEA might reduce the risk of heart

disease, perhaps by lowering cholesterol levels. DHEA may also be a

blood thinner, an effect that in theory should help protect against

heart disease.17 However, most research supports the idea that DHEA

protects against heart disease only weakly for men, and not at all

for women.18 19 In fact, higher levels of DHEA and DHEAS have been

associated with cardiovascular risk factors in women, including high

blood pressure and smoking.20 Moreover, DHEA has also been reported

to lower HDL (the " good " cholesterol).21 Until more is known, DHEA

should not be used to protect against heart disease.

 

Claims have appeared that DHEA is an anti-aging hormone. However, the

fact that young people have higher levels of DHEA than older people

does not necessarily mean that supplementing DHEA will make people

younger. In some,22 but not all,23 double-blind trials, DHEA has

improved the sense of well being in elderly individuals. In one

double-blind trial, DHEA supplementation did appear to reduce some of

the adverse effects of aging, though it did not

create " supermen/superwomen. " 24 In that trial, healthy elderly women

and men were given either 50 mg of DHEA or a placebo daily for one

year. In addition to a re-establishment of more youthful levels of

DHEAS, slight increases were also observed in other hormones, such as

testosterone and estrogens. In women over 70 year of age, bone

mineral loss was improved. A significant increase in most measures of

libido was also seen in these older women. Improvements of the skin

were also observed in both women and men, but particularly in women,

in terms of hydration, thickness, pigmentation and production of

sebum (oily secretion that lubricates the skin and hair).

 

Systemic lupus erythematosus (SLE), an autoimmune disease, has been

linked to abnormalities in sex hormone metabolism.25 Supplementation

with very large amounts of DHEA (200 mg per day) improved clinical

status and reduced the number of exacerbations of SLE in a double-

blind trial.26 A preliminary trial has confirmed the benefit of 50–

200 mg per day of DHEA for people with SLE.27

 

DHEA may play some role in protecting against depression. Low DHEA

levels have been reported in older women suffering from this

condition, though at least one report has linked severe depression to

increased DHEA levels. After six months using 50 mg DHEA per day, " a

remarkable increase in perceived physical and psychological well-

being " was reported in both men and women in one double-blind

trial.28 In another double-blind trial, after only six weeks of

taking DHEA at levels up to 90 mg per day, at least a 50% reduction

in depression was seen in five of eleven patients.29 Other

researchers have reported dramatic reductions in depression at

extremely high amounts of DHEA (90–450 mg per day) given for six

weeks to adults who first became depressed after age 40 (in men) or

at the time of menopause (in women) in a double-blind trial.30

Limiting supplementation to only two weeks is inadequate in treating

people with depression.31

 

Despite the dramatic results reported in trials lasting at least six

weeks, some experts claim that in clinical practice, DHEA appears to

be effective for only a minority of depressed people.32 Moreover, due

to fears of potential side effects, most healthcare professionals

remain concerned about the use of DHEA. As with other uses of DHEA,

depressed people should not take this hormone without supervision

from a healthcare professional.

 

Where is it found? DHEA is produced by the adrenal glands. A

synthetic form of this hormone is also available as a supplement in

tablet, capsule, liquid, and sublingual form. Some products claim to

contain " natural " DHEA precursors from wild yam. However, the body

cannot convert these substances into DHEA33 (although a series of

reactions in a laboratory can make the conversion).

 

Dehydroepiandrosterone (DHEA) has been used in connection with the

following conditions (refer to the individual health concern for

complete information):

 

Addison's Disease (to correct deficiency)

Depression

Erectile dysfunction

HIV support (for fatigue and depression)

Lupus

Alzheimer's Disease

Chronic fatigue syndrome

Immune Function

Menopause

Multi-infarct dementia

Osteoporosis

Weight loss

 

Reliable and relatively consistent scientific data showing a

substantial health benefit.

Contradictory, insufficient, or preliminary studies suggesting a

health benefit or minimal health benefit.

 

An herb is primarily supported by traditional use, or the herb or

supplement has little scientific support and/or minimal health

benefit.

 

Who is likely to be deficient? Meaningful levels of DHEA do not

appear in food, and therefore dietary deficiency does not exist. Some

people, however, may not synthesize enough DHEA. DHEA levels peak in

early adulthood and then start a lifelong descent. By the age of 60,

DHEA levels are only about 5–15% of what they were at their peak at

younger ages.34 Whether the lower level associated with age

represents a deficiency or a normal part of aging that should not be

tampered with remains unknown.

 

People with true adrenal insufficiency (i.e., Addison's Disease; not

the hypothetical adrenal " fatigue " or " burnout " that is sometimes

incorrectly referred to as " insufficiency " ) have below normal levels

of DHEA. When women with adrenal insufficiency were treated with 50

mg of DHEA every morning for three or four months, their DHEA and

DHEAS levels returned to normal, with a simultaneous improvement in

well-being and sexuality.35 36

 

Some studies have reported lower DHEA levels in groups of depressed

patients.37 38 However, in one trial, severely depressed people were

reported to show increases in blood levels of DHEA.39 Despite these

contradictory findings, a few clinical trials suggest that at least

some people who are depressed may benefit from DHEA supplementation.

(See " What does it do? " above for more information about use of DHEA

supplements in the treatment of depression.)

 

People with multi-infarct dementia (deterioration of mental functions

resulting from multiple small strokes) may have lower than normal

DHEAS levels, according to a preliminary trial.40 In this trial,

intravenous injection of 200 mg per day of DHEAS for four weeks

increased DHEAS levels and improved some aspects of mental function

and performance of daily activities.

 

People infected with HIV41 and those with insulin-dependent

diabetes,42 congestive heart failure,43 multiple sclerosis, 44

asthma,45 46 chronic fatigue syndrome,47 48 rheumatoid arthritis,49

50 51 osteoporosis, and a host of other conditions have been reported

to have low levels of DHEA in most,52 but not all, studies.53 54 In

most cases, the meaning of this apparent deficiency is not well

understood.

 

Men under 60 years of age with erectile dysfunction have been found

to have lower DHEAS levels than men without the condition.55

(See " What does it do? " above for more information about use of DHEA

supplements in the treatment of men with erectile dysfunction.)

Most,56 57 58 59 but not all, 60 61 studies have found that people

with Alzheimer's disease have lower blood DHEAS levels than do people

without the condition.

 

How much is usually taken? Most people do not need to supplement

DHEA. The question of who should take this hormone remains

controversial. Some experts believe that daily intakes of 5–15 mg of

DHEA for women and 10–30 mg for men are appropriate amounts for

people with deficient blood levels of DHEA or DHEAS.62 While a few

researchers suggest supplementation with as much as 50 mg per day in

postmenopausal women,63 others consider this level excessive.64

People should consult a doctor to have DHEA levels monitored before

and during supplementation. Healthy people with normal blood levels

of DHEA or DHEAS should not take this hormone until more is known

about its effects. However, some doctors recommend DHEA

supplementation for selected people with depression, autoimmune

diseases, or other problems, even if their blood levels are normal.

 

People with systemic lupus erythematosus (SLE) have been shown to

improve after taking 100–200 mg per day of DHEA. Such large amounts

should never be taken without medical supervision.

 

Discrepancies between label claims and actual DHEA content of DHEA

supplements have been reported.65 Regrettably, the authors of this

report failed to identify which brands were properly labeled and

which were not.

 

Are there any side effects or interactions? Experts have concerns

about the use of DHEA, particularly because long-term safety data do

not exist.

 

Side effects at high intakes (50–200 mg per day) appear to be acne

(in over 50% of people), increased facial hair (18%), and increased

perspiration (8%). In a preliminary trial, DHEA was also reported to

induce less common side effects, including breast tenderness, weight

gain, mood alteration, headache, oily skin, and menstrual

irregularity in some people.66 Since this trial was not controlled,

some of these less common " side effects " might have occurred even

with a placebo. A case of mania has been reported in an older man who

took 200–300 mg of DHEA per day for six months.67 However, in that

case report, other causes of mania could not be ruled out.

 

Significant increases in testosterone levels in both men and women

have been reported in some trials.68 69 Other reports have found this

change in women but not in men.70 An increase in testosterone might

increase the risk of several cancers, and high amounts of DHEA have

caused cancer in animals.71 72 Moreover, a possible link between

higher DHEA levels and risks of prostate cancer in humans has been

reported.73 At least one person with prostate cancer has been

reported to have had a worsening of his cancer, despite feeling

better, while taking very high amounts (up to 700 mg per day) of

DHEA.74

 

While younger women with breast cancer may have low levels of DHEA,

postmenopausal women with breast cancer appear to have high levels of

DHEA, which has researchers concerned.75 76 Most,77 78 79 80 81 but

not all, studies82 83 84 have found that as DHEA blood levels

increase, so does the risk of breast cancer.

 

Supplementation with high levels of DHEA (100 mg per day) has

adversely affected other indicators of cancer risk in both women and

men.85 86 Elevated DHEA levels have been reported to be associated

with both higher,87 and lower risk for ovarian cancer.88 The reason

for this discrepancy is unknown.

 

The lack of knowledge about how DHEA supplementation might affect

cancer risks provides a reason for caution. Until more is known,

people with breast or prostate cancer or a family history of these

conditions should avoid supplementing with DHEA.

Although anticancer effects of DHEA have also been reported,89 they

involve trials using animals that do not process DHEA the way humans

do. Therefore, these positive effects may have no relevance for

people.

 

Some doctors recommend that people taking DHEA have liver enzymes

measured routinely. Anecdotes of DHEA supplementation (of at least 25

mg per day) leading to heart arrhythmias have appeared.90

 

The relationship between DHEA, blood pressure, and heart disease is

poorly understood. Increased blood levels of DHEAS have been

associated with increased blood pressure91 and other cardiovascular

risk factors in some,92 but not all,93 studies. One study found that

people with hypertension had significantly decreased blood levels of

DHEA.94 Until clinical trials clear up these inconsistencies and

confirm its safety, people with hypertension should avoid using DHEA,

except under the close supervision of a doctor.

At only 25 mg per day, DHEA has lowered HDL cholesterol while

increasing insulin-like growth factor (IGF).95 Decreasing HDL could

increase the risk of heart disease. Increasing IGF might increase the

risk of breast cancer.

 

Are there any drug interactions? Certain medications may interact

with dehydroepiandrosterone. Refer to the drug interactions safety

check for a list of those medications.

 

Dr. Arron Bowen

Columbia University Hospital, NYC

 

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